经过有限培训的急诊医师在床旁超声心动图中的表现。

Performance of emergency physicians in point-of-care echocardiography following limited training.

机构信息

Department of Trauma and Emergency Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia.

Department of Cardiology, University of Malaya Medical Centre, Kuala Lumpur, Malaysia.

出版信息

Emerg Med J. 2014 May;31(5):369-73. doi: 10.1136/emermed-2012-201789. Epub 2013 Feb 21.

DOI:10.1136/emermed-2012-201789

PMID:23428721

Abstract

OBJECTIVES

The aim of this study was to evaluate if emergency medicine trainees with a short duration of training in echocardiography could perform and interpret bedside-focused echocardiography reliably on emergency department patients.

METHODS

Following a web-based learning module and 3 h of proctored practical training, emergency medicine trainees were evaluated in technical and interpretative skills in estimating left ventricular function, detection of pericardial effusion and inferior vena cava (IVC) diameter measurements using bedside-focused echocardiography on emergency department patients. An inter-rater agreement analysis was performed between the trainees and a board-certified cardiologist.

RESULTS

100 focused echocardiography examinations were performed by nine emergency medicine trainees. Agreement between the trainees and the cardiologist was 93% (K=0.79, 95% CI 0.773 to 0.842) for visual estimation of left ventricular function, 92.9% (K=0.80, 95% CI 0.636 to 0.882) for quantitative left ventricular ejection fraction by M-mode measurements, 98% (K=0.74, 95% CI 0.396 to 1.000) for the detection of pericardial effusion, and 64.2% (K=0.45, 95% CI 0.383 to 0.467) for IVC diameter assessment. The Bland-Altman limits of agreement for left ventricular function was -9.5% to 13.7%, and a Pearson's correlation yielded a value of 0.82 (p<0.0001, 95% CI 0.734 to 0.881). The trainees detected pericardial effusion with a sensitivity of 60%, specificity of 100%, positive predictive value of 100% and negative predictive value of 97.9%.

CONCLUSIONS

Emergency medicine trainees were found to be able to perform and interpret focused echocardiography reliably after a short duration of training.

摘要

目的

本研究旨在评估经过短期超声心动图培训的急诊医学住院医师是否能够对急诊科患者进行可靠的床旁重点超声心动图检查和解读。

方法

在进行基于网络的学习模块和 3 小时的监督实践培训后，对急诊医学住院医师进行技术和解读技能评估，评估内容包括使用床旁重点超声心动图对急诊科患者进行左心室功能评估、检测心包积液和下腔静脉（IVC）直径测量。对住院医师和一名经过委员会认证的心脏病专家进行了观察者间一致性分析。

结果

9 名急诊医学住院医师共进行了 100 次重点超声心动图检查。住院医师与心脏病专家的一致性为 93%（K=0.79，95%CI 0.773 至 0.842），用于评估左心室功能的视觉估计；92.9%（K=0.80，95%CI 0.636 至 0.882），用于 M 模式测量的定量左心室射血分数；98%（K=0.74，95%CI 0.396 至 1.000），用于检测心包积液；64.2%（K=0.45，95%CI 0.383 至 0.467），用于 IVC 直径评估。左心室功能的 Bland-Altman 一致性界限为-9.5%至 13.7%，Pearson 相关系数为 0.82（p<0.0001，95%CI 0.734 至 0.881）。住院医师检测心包积液的敏感性为 60%，特异性为 100%，阳性预测值为 100%，阴性预测值为 97.9%。